AFL 20-38.4 From the California Department of Public Health
August 7, 2020
TO: All Facilities
SUBJECT: Visitor Limitations Guidance (This AFL supersedes AFL 20-38.3)
All Facilities Letter (AFL) Summary
- This AFL notifies all facilities of updated visitor guidelines for pediatric patients, patients in labor and delivery, neonatal intensive care unit (NICU) patients, pediatric intensive care unit patients (PICU) patients, and patients at end-of-life and patients with physical, intellectual, and/or developmental disabilities and patients with cognitive impairments.
- Health facilities may permit a support person to accompany a patient for whom a support person has been determined to be essential to the care of the patient (medically necessary), including patients with physical, intellectual, and/or developmental disabilities and patients with cognitive impairments.
- This AFL has been updated to clarify that long-term care facilities and hospitals may permit students obtaining their clinical experience into the facility if they meet the CDC guidelines for healthcare workers. This revision also clarifies when a doula may be permitted during labor and delivery.
Due to the community spread of Coronavirus Disease 2019 (COVID-19), considerations must be made for the safety of health facility staff and patients, resulting in many health care facilities suspending visitation, except when medically necessary or essential to the care of the patient. The California Department of Public Health (CDPH) recognizes the importance that visitors play in the mental well-being of patients, including pediatric patients, NICU and PICU patients, patients in labor and delivery, and patients at end-of-life. CDPH also recognizes the importance of ensuring people with disabilities receive the support they need while hospitalized. CDPH considers visitors an essential part of patient care and recovery.
CDPH has developed recommended visitor guidelines for certain patients to ensure support for their mental health and well-being, while striving to limit the spread of the virus.
- Visitors are essential for the mental health of pediatric patients. CDPH recommends that pediatric patients be allowed one support person.
- In the case of prolonged hospitalization, CDPH recommends two designated support persons for pediatric patients, provided that only one visitor is present at a time.
- For NICU and PICU patients, CDPH recommends two designated support persons that may visit at the same time.
Labor and Delivery Patients
- The presence of a partner or support person is essential to the mental health of patients who are in labor and delivery. CDPH recommends that one support person and be allowed to be present with the patient. CDPH also recommends that a doula, if used, be permitted to be present if prior arrangements have been made with the hospital and the doula complies with hospital PPE and infection control guidelines.
Patients at End-of-Life
- Visitors are essential to the mental health of patients who are at end-of-life. For their continued mental health, and well-being, the department recommends that one visitor be allowed to be present with the patient.
Patients with Physical, Intellectual, and/or Developmental Disabilities and Patients Cognitive Impairments
- The presence of a support person is essential to patients with physical, intellectual, and/or developmental disabilities and patients with cognitive impairments. CDPH recommends that one support person be allowed to be present with the patient when medically necessary.
- For hospitalized patients, especially with prolonged hospitalization, the patient or family/patient representative may designate two support people, but only one support person may be present at a time.
Students Obtaining Clinical Experience
- CDPH supports efforts to help ensure that new nurses and other professionals coming into the healthcare workforce are able to obtain necessary clinical experience. CDPH encourages students obtaining their clinical experience be permitted to come into the facility if they meet the CDC guidelines for healthcare workers to maintain the workforce needed during this pandemic.
All support persons must stay in the room and be asymptomatic for COVID-19 and not be a suspected or recently confirmed case. Support persons may be screened prior to entering clinical areas. Support persons must comply with any health facility instructions on personal protective equipment.
Additionally, CDPH strongly encourages facilities, including but not limited to skilled nursing facilities, to create ways for residents and patients to have frequent video and phone call visits. If shared devices are used for video calls facilities should ensure appropriate infection control measures are in place.
If you have any questions about this AFL, please contact your local district office.
Original signed by Heidi W. Steinecker
Heidi W. Steinecker